Porosity and pore design influence on fatigue behavior of 3D printed scaffolds for trabecular bone replacement

Finite element analysis and in vitro tests on endurance life and durability of composite bone substitutes

Bone structures facilitate the regeneration and repair of bone tissue in regions where it has been damaged or destroyed, either temporarily or permanently. Therefore, the bone's fatigue strength and durability are crucial to its efficacy and longevity. Several variables, such as the construct's material qualities, design, and production procedure, loading and unloading cycles, and physiological conditions influence the endurance life of bone constructs. Metals, ceramics, and polymers are all routinely utilized to create bone substitutes, and each of these materials has unique features that might affect the fatigue strength and endurance life of the final product. The mechanical performance and capacity to promote bone tissue regeneration may be affected by the scaffold's design, porosity, and pore size. Researchers employ mechanical testing under cyclic loading circumstances as one example of an experimental approach used to assess bone construction endurance. These analyses can give us important information about the stress-strain behavior, resistance to multiple loading cycles, and fatigue strength of the new structure. Predicting the endurance life of the developed construct may also be possible with the use of simulations and numerical analyses. Hence, in order to create reliable and efficient constructs for bone tissue engineering, it is crucial to understand their fatigue strength and durability. The purpose of this study is to analyze the effective parameters for fatigue strength of bone structures and to gather the models and evaluations utilized in endurance life assessments.

Fatigue Performance of 3D-Printed Poly-Lactic-Acid Bone Scaffolds with Triply Periodic Minimal Surface and Voronoi Pore Structures

Bone scaffolds serve a crucial role in tissue engineering, particularly in facilitating bone regeneration where natural repair is insufficient. Despite advancements in the fabrication of polymeric bone scaffolds, the challenge remains to optimize their mechanical resilience. Specifically, research on the fatigue behaviour of polymeric bone scaffolds is scarce. This study investigates the influence of pore architecture on the mechanical performance of poly-lactic-acid (PLA) scaffolds under quasi-static and cyclic compression. PLA scaffolds with a 60% porosity were fabricated using extrusion-based 3D printing in various designs: Gyroid, Lidinoid, Fischer-Koch, IWP, and Voronoi. Results demonstrated that Gyroid scaffolds had the highest compressive strength (6.6 MPa), followed by Lidinoid, Fischer-Koch, IWP, and Voronoi designs. Increased strut thickness was linked to higher compressive strength. However, normalized fatigue resistance showed a different pattern. While scaffolds resisted fatigue cycles at low strain amplitudes, fatigue damage was observed at higher strains. Voronoi structures exhibited the highest normalized fatigue performance, enduring around 58,000 cycles at 85% strain amplitude, followed by Gyroid, Fischer-Koch, Lidinoid, and IWP structures. Enhanced fatigue performance in different topologies correlated with the minimum cross-sectional area of scaffolds. Given the importance of both static and fatigue strength, the Gyroid topology emerges as the superior choice overall.

An explainable machine learning-based probabilistic framework for the design of scaffolds in bone tissue engineering

Recently, 3D-printed biodegradable scaffolds have shown great potential for bone repair in critical-size fractures. The differentiation of the cells on a scaffold is impacted among other factors by the surface deformation of the scaffold due to mechanical loading and the wall shear stresses imposed by the interstitial fluid flow. These factors are in turn significantly affected by the material properties, the geometry of the scaffold, as well as the loading and flow conditions. In this work, a numerical framework is proposed to study the influence of these factors on the expected osteochondral cell differentiation. The considered scaffold is rectangular with a 0/90 lay-down pattern and a four-layered strut made of polylactic acid with a 5% steel particle content. The distribution of the different types of cells on the scaffold surface is estimated through a scalar stimulus, calculated by using a mechanobioregulatory model. To reduce the simulation time for the computation of the stimulus, a probabilistic machine learning (ML)-based reduced-order model (ROM) is proposed. Then, a sensitivity analysis is performed using the Shapley additive explanations to examine the contribution of the various parameters to the framework stimulus predictions. In a final step, a multiobjective optimization procedure is implemented using genetic algorithms and the ROM, aiming to identify the material parameters and loading conditions that maximize the percentage of surface area populated by bone cells while minimizing the area corresponding to the other types of cells and the resorption condition. The results of the performed analysis highlight the potential of using ROMs for the scaffold design, by dramatically reducing the simulation time while enabling the efficient implementation of sensitivity analysis and optimization procedures.

Fatigue behaviour of load-bearing polymeric bone scaffolds: A review

Bone scaffolds play a crucial role in bone tissue engineering by providing mechanical support for the growth of new tissue while enduring static and fatigue loads. Although polymers possess favourable characteristics such as adjustable degradation rate, tissue-compatible stiffness, ease of fabrication, and low toxicity, their relatively low mechanical strength has limited their use in load-bearing applications. While numerous studies have focused on assessing the static strength of polymeric scaffolds, little research has been conducted on their fatigue properties. The current review presents a comprehensive study on the fatigue behaviour of polymeric bone scaffolds. The fatigue failure in polymeric scaffolds is discussed and the impact of material properties, topological features, loading conditions, and environmental factors are also examined. The present review also provides insight into the fatigue damage evolution within polymeric scaffolds, drawing comparisons to the behaviour observed in natural bone. Additionally, the effect of polymer microstructure, incorporating reinforcing materials, the introduction of topological features, and hydrodynamic/corrosive impact of body fluids in the fatigue life of scaffolds are discussed. Understanding these parameters is crucial for enhancing the fatigue resistance of polymeric scaffolds and holds promise for expanding their application in clinical settings as structural biomaterials. STATEMENT OF SIGNIFICANCE: Polymers have promising advantages for bone tissue engineering, including adjustable degradation rates, compatibility with native bone stiffness, ease of fabrication, and low toxicity. However, their limited mechanical strength has hindered their use in load-bearing scaffolds for clinical applications. While prior studies have addressed static behaviour of polymeric scaffolds, a comprehensive review of their fatigue performance is lacking. This review explores this gap, addressing fatigue characteristics, failure mechanisms, and the influence of parameters like material properties, topological features, loading conditions, and environmental factors. It also examines microstructure, reinforcement materials, pore architectures, body fluids, and tissue ingrowth effects on fatigue behaviour. A significant emphasis is placed on understanding fatigue damage progression in polymeric scaffolds, comparing it to natural bone behaviour.

Customized Additive Manufacturing in Bone Scaffolds-The Gateway to Precise Bone Defect Treatment

In the advancing landscape of technology and novel material development, additive manufacturing (AM) is steadily making strides within the biomedical sector. Moving away from traditional, one-size-fits-all implant solutions, the advent of AM technology allows for patient-specific scaffolds that could improve integration and enhance wound healing. These scaffolds, meticulously designed with a myriad of geometries, mechanical properties, and biological responses, are made possible through the vast selection of materials and fabrication methods at our disposal. Recognizing the importance of precision in the treatment of bone defects, which display variability from macroscopic to microscopic scales in each case, a tailored treatment strategy is required. A patient-specific AM bone scaffold perfectly addresses this necessity. This review elucidates the pivotal role that customized AM bone scaffolds play in bone defect treatment, while offering comprehensive guidelines for their customization. This includes aspects such as bone defect imaging, material selection, topography design, and fabrication methodology. Additionally, we propose a cooperative model involving the patient, clinician, and engineer, thereby underscoring the interdisciplinary approach necessary for the effective design and clinical application of these customized AM bone scaffolds. This collaboration promises to usher in a new era of bioactive medical materials, responsive to individualized needs and capable of pushing boundaries in personalized medicine beyond those set by traditional medical materials.

Multi-objective numerical optimization of 3D-printed polylactic acid bio-metamaterial based on topology, filling pattern, and infill density via fatigue lifetime and mass

Infill parameters are significant with regard to the overall cost and saving material while printing a 3D model. When it comes to printing time, we can decrease the printing time by altering the infill, which also reduces the total process extent. Choosing the right filling parameters affects the strength of the printed model. In this research, the effect of filling density and infill pattern on the fatigue lifetime of cylindrical polylactic acid (PLA) samples was investigated with finite element modeling and analysis. This causes the lattice structure to be considered macro-scale porosity in the additive manufacturing process. Due to the need for multi-objective optimization of several functions at the same time and the inevitable sacrifice of other objectives, the decision was to obtain a set of compromise solutions according to the Pareto-optimal solution technique or the Pareto non-inferior solution approach. As a result, a horizontally printed rectangular pattern with 60% filling was preferred over the four patterns including honeycomb, triangular, regular octagon, and irregular octagon by considering the sum of mass changes and fatigue lifetime changes, and distance from the optimal point, which is the lightest structure with the maximum fatigue lifetime as an objective function with an emphasis on mass as an important parameter in designing scaffolds and biomedical structures. A new structure was also proposed by performing a structural optimization process using computer-aided design tools and also, computer-aided engineering software by Dassault systems. Finally, the selected samples were printed and their 3D printing quality was investigated using field emission scanning electron microscopy inspection.

Use of 3D-printed polylactic acid/bioceramic composite scaffolds for bone tissue engineering in preclinical in vivo studies: A systematic review

3D-printed composite scaffolds have emerged as an alternative to deal with existing limitations when facing bone reconstruction. The aim of the study was to systematically review the feasibility of using PLA/bioceramic composite scaffolds manufactured by 3D-printing technologies as bone grafting materials in preclinical in vivo studies. Electronic databases were searched using specific search terms, and thirteen manuscripts were selected after screening. The synthesis of the scaffolds was carried out using mainly extrusion-based techniques. Likewise, hydroxyapatite was the most used bioceramic for synthesizing composites with a PLA matrix. Among the selected studies, seven were conducted in rats and six in rabbits, but the high variability that exists regarding the experimental process made it difficult to compare them. Regarding the results, PLA/Bioceramic composite scaffolds have shown to be biocompatible and mechanically resistant. Preclinical studies elucidated the ability of the scaffolds to be used as bone grafts, allowing bone growing without adverse reactions. In conclusion, PLA/Bioceramics scaffolds have been demonstrated to be a promising alternative for treating bone defects. Nevertheless, more care should be taken when designing and performing in vivo trials, since the lack of standardization of the processes, which prevents the comparison of the results and reduces the quality of the information. STATEMENT OF SIGNIFICANCE: 3D-printed polylactic acid/bioceramic composite scaffolds have emerged as an alternative to deal with existing limitations when facing bone reconstruction. Since preclinical in vivo studies with animal models represent a mandatory step for clinical translation, the present manuscript analyzed and discussed not only those aspects related to the selection of the bioceramic material, the synthesis of the implants and their characterization. But provides a new approach to understand how the design and perform of clinical trials, as well as the selection of the analysis methods, may affect the obtained results, by covering authors' knowledgebase from veterinary medicine to biomaterial science. Thus, this study aims to systematically review the feasibility of using polylactic acid/bioceramic scaffolds as grafting materials in preclinical trials.

Additive manufacturing of sustainable biomaterials for biomedical applications

Biopolymers are promising environmentally benign materials applicable in multifarious applications. They are especially favorable in implantable biomedical devices thanks to their excellent unique properties, including bioactivity, renewability, bioresorbability, biocompatibility, biodegradability and hydrophilicity. Additive manufacturing (AM) is a flexible and intricate manufacturing technology, which is widely used to fabricate biopolymer-based customized products and structures for advanced healthcare systems. Three-dimensional (3D) printing of these sustainable materials is applied in functional clinical settings including wound dressing, drug delivery systems, medical implants and tissue engineering. The present review highlights recent advancements in different types of biopolymers, such as proteins and polysaccharides, which are employed to develop different biomedical products by using extrusion, vat polymerization, laser and inkjet 3D printing techniques in addition to normal bioprinting and four-dimensional (4D) bioprinting techniques. This review also incorporates the influence of nanoparticles on the biological and mechanical performances of 3D-printed tissue scaffolds. This work also addresses current challenges as well as future developments of environmentally friendly polymeric materials manufactured through the AM techniques. Ideally, there is a need for more focused research on the adequate blending of these biodegradable biopolymers for achieving useful results in targeted biomedical areas. We envision that biopolymer-based 3D-printed composites have the potential to revolutionize the biomedical sector in the near future.

Influence of Trabecular Geometry on Scaffold Mechanical Behavior and MG-63 Cell Viability

In a scaffold-based approach for bone tissue regeneration, the control over morphometry allows for balancing scaffold biomechanical performances. In this experimental work, trabecular geometry was obtained by a generative design process, and scaffolds were manufactured by vat photopolymerization with 60% (P60), 70% (P70) and 80% (P80) total porosity. The mechanical and biological performances of the produced scaffolds were investigated, and the results were correlated with morphometric parameters, aiming to investigate the influence of trabecular geometry on the elastic modulus, the ultimate compressive strength of scaffolds and MG-63 human osteosarcoma cell viability. The results showed that P60 trabecular geometry allows for matching the mechanical requirements of human mandibular trabecular bone. From the statistical analysis, a general trend can be inferred, suggesting strut thickness, the degree of anisotropy, connectivity density and specific surface as the main morphometric parameters influencing the biomechanical behavior of trabecular scaffolds, in the perspective of tissue engineering applications.

Effects of surface patterning and topography on the cellular functions of tissue engineered scaffolds with special reference to 3D bioprinting

The extracellular matrix (ECM) of the tissue organ exhibits a topography from the nano to micrometer range, and the design of scaffolds has been inspired by the host environment. Modern bioprinting aims to replicate the host tissue environment to mimic the native physiological functions. A detailed discussion on the topographical features controlling cell attachment, proliferation, migration, differentiation, and the effect of geometrical design on the wettability and mechanical properties of the scaffold are presented in this review. Moreover, geometrical pattern-mediated stiffness and pore arrangement variations for guiding cell functions have also been discussed. This review also covers the application of designed patterns, gradients, or topographic modulation on 3D bioprinted structures in fabricating the anisotropic features. Finally, this review accounts for the tissue-specific requirements that can be adopted for topography-motivated enhancement of cellular functions during the fabrication process with a special thrust on bioprinting.

Effects of ceramic additives and bioactive coatings on the degradation of polylactic acid-based bone scaffolds under hydrolytic conditions

Polylactic acid (PLA) has been extensively used for the manufacturing of scaffolds in bone tissue engineering applications. Due to the low hydrophilicity and the acidic degradation process of this biomaterial, different strategies have been proposed to increase the biofunctionality of the support structure. The use of ceramic particles is a generally preferred option to increase the osteoconductivity of the base material, while acting as buffers to maintain the pH level of the surroundings tissues. Surface modification is another approach to overcome the limitations of PLA for tissue engineering applications. In this work, the degradation profile of 3D-printed PLA scaffolds containing beta-tricalcium phosphate (β-TCP) and calcium carbonate (CaCO3 ) particles has been studied under hydrolytic conditions. Composite samples treated with plasma and coated with Aloe vera extracts were also studied to evaluate the effect of this surface modification method. The characterization of the 3D structures included its morphological, calorimetric and mechanical evaluation. According to the results obtained, the proposed composite scaffolds allowed an adequate maintenance of the pH level of the surrounding medium, with no effects observed on the morphology and mechanical properties of these structures. Hence, these samples showed potential to be further investigated as candidates for bone tissue regeneration.

Biocompatibility and osteointegration capability of β-TCP manufactured by stereolithography 3D printing: In vitro study

Beta-tricalcium phosphate (β-TCP) bioceramics have an inorganic composition similar to the human bone. While conventional methods can only produce ceramic scaffolds with poor controllability, the advancement of 3D-printing, especially stereolithography, made it possible to manufacture controllable, highly precise, micropore ceramic scaffolds. In this study, the stereolithography was applied to produce β-TCP bioceramics, while ZrO₂, Al₂O₃, Ti6Al4V, and polyetheretherketone (PEEK) were used as controls. Phase analysis, water contact angle tests, and Micro-CT were applied to evaluate the surface properties and scaffold. Hemolytic toxicity, cell proliferation, and morphological assessment were performed to evaluate the biocompatibility. Alkaline phosphatase (ALP) level, mineralization, and qRT-PCR were measured to evaluate the osteointegration. During the manufacturing of β-TCP, no evident impurity substance and hemolytic toxicity was found. Cells on β-TCP had good morphologies, and their proliferation capability was similar to Ti6Al4V, which was higher than the other materials. Cells on β-TCP had higher ALP levels than PEEK. The degree of mineralization was significantly higher on β-TCP. The expression of osteogenesis-related genes on β-TCP was similar to Ti6Al4V and higher than the other materials. In this study, the β-TCP produced by stereolithography had no toxicity, high accuracy, and excellent osteointegration capability, thus resulting as a good choice for bone implants.

Optimizing Design Parameters of PLA 3D-Printed Scaffolds for Bone Defect Repair

Current materials used to fill bone defects (ceramics, cement) either lack strength or do not induce bone repair. The use of biodegradable polymers such as PLA may promote patient healing by stimulating the production of new bone in parallel with a controlled degradation of the scaffold. This project aims to determine the design parameters maximising scaffold mechanical performance in such materials. Starting from a base cylindrical model of 10 mm height and of outer and inner diameters of 10 and 4 mm, respectively, 27 scaffolds were designed. Three design parameters were investigated: pore distribution (crosswise, lengthwise, and eccentric), pore shape (triangular, circular, and square), and pore size (surface area of 0.25 mm2, 0.5625 mm2, and 1 mm2). Using the finite element approach, a compressive displacement (0.05 mm/s up to 15% strain) was simulated on the models and the resulting scaffold stiffnesses (N/mm2) were compared. The models presenting good mechanical behaviors were further printed along two orientations: 0° (cylinder sitting on its base) and 90° (cylinder laying on its side). A total of n = 5 specimens were printed with PLA for each of the retained models and experimentally tested using a mechanical testing machine with the same compression parameters. Rigidity and yield strength were evaluated from the experimental curves. Both numerically and experimentally, the highest rigidity was found in the model with circular pore shape, crosswise pore distribution, small pore size (surface area of 0.25 mm2), and a 90° printing orientation. Its average rigidity reached 961 ± 32 MPa from the mechanical testing and 797 MPa from the simulation, with a yield strength of 42 ± 1.5 MPa. The same model with a printing orientation of 0° resulted in an average rigidity of 515 ± 7 MPa with a yield strength of 32 ± 1.6 MPa. Printing orientation and pore size were found to be the most influential design parameters on rigidity. The developed design methodology should accelerate the identification of effective scaffolds for future in vitro and in vivo studies.

Revealing the compressive and flow properties of novel bone scaffold structure manufactured by selective laser sintering technique

Additive manufacturing is revolutionizing the field of medical sciences through its key application in the development of bone scaffolds. During scaffold fabrication, achieving a good level of porosity for enhanced mechanical strength is very challenging. The bone scaffolds should hold both the porosity and load withstanding capacity. In this research, a novel structure was designed with the aim of the evaluation of flexible porosity. A CAD model was generated for the novel structure using specific input parameters, whereas the porosity was controlled by varying the input parameters. Poly Amide (PA 2200) material was used for the fabrication of bone scaffolds, which is a biocompatible material. To fabricate a novel structure for bone scaffolds, a Selective Laser Sintering machine (SLS) was used. The displacement under compression loads was observed using a Universal Testing Machine (UTM). In addition to this, numerical analysis of the components was also carried out. The compressive stiffness found through the analysis enables the verification of the load withstanding capacity of the specific bone scaffold model. The experimental porosity was compared with the theoretical porosity and showed almost 29% to 30% reductions when compared to the theoretical porosity. Structural analysis was carried out using ANSYS by changing the geometry. Computational Fluid Dynamics (CFD) analysis was carried out using ANSYS FLUENT to estimate the blood pressure and Wall Shear Stress (WSS). From the CFD analysis, maximum pressure of 1.799 Pa was observed. Though the porosity was less than 50%, there was not much variation of WSS. The achievement from this study endorses the great potential of the proposed models which can successfully be adapted for the required bone implant applications.

Design, evaluation, and optimization of 3D printed truss scaffolds for bone tissue engineering

One of tissue engineering's main goals is to fabricate three-dimensional (3D) scaffolds with interconnected pores to reconstruct and regenerate damaged or deformed tissues and organs. In this regard, 3D printing is a promising technique for the fabrication of tissue scaffolds, which can precisely make predetermined and complicated architectures. This study aims to investigate and optimize the physical, mechanical, and biological properties of 3D truss architecture tissue scaffolds with different pore geometries. The mechanical properties of poly (methyl methacrylate) scaffolds are analysed experimentally and numerically. Furthermore, the mechanical and physical properties of scaffolds are optimized with response surface methodology (RSM), and cell adhesion of the 3D truss scaffold studies. Results demonstrate that mechanical properties of the simple and gradient scaffolds have different mechanical behaviors that are strongly correlated with pore size and their architectures, rather than merely the values of the porosity. It is also observed that the RSM technique can enable designers to enhance mechanical and physical properties of scaffolds at low cost. Moreover, the results of biological behaviour can endorse the reliability of 3D truss architecture in bone tissue engineering.